Well-Track

Health Innovation East Midlands worked with Northamptonshire Healthcare NHS Foundation Trust to evaluate the Trust’s Well-Track intervention to improve the physical and mental health of people using their mental health services.

The challenge

Compared to levels in the general population, people who experience mental health issues often have poorer physical fitness, more sedentary behaviour, lower physical activity, poorer sleep quality, and higher incidence of insomnia. Physical activity and sleep are interconnected with mental health, physical health, wellbeing, quality of life, cognition, and day-to-day functioning.

Appropriate levels of physical activity are beneficial for mental and physical health, wellbeing and functioning, and can reduce symptoms of mental illness.

Disturbed night-time sleep (insomnia symptoms, e.g., difficulty in initiating or maintaining sleep) is highly prevalent in depression (up to 40%), and compared with the general population, more people with depression report that sleep is less refreshing (Gupta et al., 2009; Nutt et al., 2008).

The solution

The Well-Track intervention uses an individualised approach to wellbeing that includes a wearable activity and sleep tracker (Fitbit); one session with mental health service staff providing physical activity and sleep hygiene advice; a brief motivational interview; completing a goal setting workbook; and one or two further engagement, feedback, and discussion sessions.

Well-Track has been shown to improve sleep quality physical activity and mental and physical health in people experiencing depression, psychosis and those at risk of severe mental illness.

The intervention has been found to be beneficial in terms of wellbeing, depression, sleep, goal achievement, confidence, social connections, resilience, motivation, and preventing weight gain (as a two or three engagement point intervention).

Well-Track has been successfully integrated into an early intervention in psychosis (EIP) and at-risk mental state (ARMS) service and it is currently being offered through memory assessments (MAS) services to people with cognitive decline but no current dementia diagnosis and to people referred to teams delivering physical health checks for serious mental illness (SMI).

A manualised version of Well-Track is now available to access free of charge via: https://www.nhft.nhs.uk/research/

Imapct and outcomes

Depression services

• People undergoing rTMS (Repetitive Transcranial Magnetic Stimulation) treatment have a period of regular contact with mental health services, there is potential value in providing a device such as the Fitbit, building on the evidence of links between increased physical activity, improved sleep, enhanced wellbeing, better physical health, and lower depressive symptoms. People experiencing depression but not receiving rTMS could also benefit from the offer of a Fitbit and its apps alongside the provision of other depression treatments; for example, when patients are offered a course of medication or psychotherapy. Fitbits could be offered through primary care (GPs) or through psychotherapy services that see people with depression such as NHS Talking Therapies.

Psychosis and at risk mental state (ARMS) services

• Well-Track can be fully integrated into EIP and ARMS services. Well-Track has a positive impact on insomnia, wellbeing, and depression either as a two or three engagement point intervention.
• There is a lack of effective physical activity interventions available in EIP services, and Well-Track is an effective option, that could potentially bridge this gap. Well-Track has demonstrated that mental health services can successfully address health and wellbeing associated lifestyle factors that are important to their patients.

Other services

Well-Track has the potential to be introduced into other healthcare services who see people who experience high levels of sleep related issues and have low physical activity levels, such as: cognitive decline/dementia services; community mental health teams (CMHT) services; depression services; gender identity services; anxiety services; bi-polar services; post-traumatic stress disorder (PTSD) services; attention deficit hyperactivity disorder (ADHD) services; physical health check for serious mental illness (SMI) teams; and child and adolescent mental health services (CAMHS).

Watch our presentation

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